Assessment of the Musculoskeletal System

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Assessment of the Musculoskeletal System

• Past health history- these includes TB, polio,
  DM, parathyroid problems, soft tissue infection,
  neuromuscular disabilities. Possible sources of
  bacterial infection, such as ears, tonsils or GU
  and trauma.
• Medications- regarding prescription, OTC, herbal
  products nutritional supplements. Women should
  be question about their menstrual hx. , use of
  hormone therapy, CA and vitamin D supplements are
  important for postmenopausal women.

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Assessment of the Musculoskeletal System

• Surgery or other treatments- past
  hospitalizations from musculoskeletal problems.
• Functional health patterns-
  Nutritional-metabolic pattern-dietary
  supplements. Elimination-
  Activity-exercise-require assistance in
  completing ADL. sleep-rest- difficulty
  sleeping. Cognitive-perceptual-musculoskeletal
  pain

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Assessment of the Musculoskeletal System

• Functional Health patterns cont..
  Self-perception-self-concept-changes in MS
  system-posture, walking,etc
  Role-relationship- live alone, effect on
  work. Sexuality-reproductive-sexual
  concerns. coping-stress tolerance-
  problems such as pain or immobility.
  value-belief- cultural religious practices.

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Assessment of the Musculoskeletal System

• Physical examination Inspection-use of an
  assistive devices such as walker. Observe general
  body build, muscle configuration, symmetry of
  joint movement. Note for swelling, deformity,
  nodules or masses discrepancies in limb length
  or muscle size.

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Assessment of the Musculoskeletal System

• Physical Examination con,t
• Palpation of both muscles joints allows
  for evaluation of skin temperature, local
  tenderness, swelling and crepitation.
• Gait, motion of spine- smoothness, rhythm,
  limpimg, unsteady. Note height of shoulders,
  iliac crests, gluteal folds, shoulder hip
  symmetry. Note for lumbar lordosis( concavity of
  the spine), kyphosis-(excessive curvature of
  thoracic spine), scoliosis (deviation to L or
  right)

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Assessment of the Musculoskeletal System

• Upper extremities- evaluate muscle strength. If
  joint motion compromised or painful-exam for
  fluid (effusion), increase temperature
  (inflammation). Passive movements elicits
  crunching noise (crepitus)-exam for nodules.
• Lower extremities- evaluate muscle action, ROM,
  pulses( femoral, tibial, dorsalis
  pedis).reflexes- (patellar, achilles, babinski)

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Assessment of the Musculoskeletal SystemMuscle
Strength scale
0 No detection of muscular contraction
1 A barely detectable flicker or trace of contraction with observation or palpation.
2 Active movement of body part with elimination of gravity.
3 Active movement against gravity only and not against resistance
4 Active movement against gravity some resistance
5 Active movement against full resistance without evident fatigue (Normal muscle strength)
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Assessment of the Musculoskeletal System

• Injured extremity- Observe for bleeding-arterial
  (spurts), venous (steady), bones (oozes, oily).
  Pressure over main artery-if pressure at the site
  doesnt work. Check for deformities- if cant
  move need attention.

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Assessment of the Musculoskeletal System

• Diagnostic tests
• X-ray- determine density of the bone.
• Arthrogram- visualization of joint structure
  movement.
• Diskogram- vizualization of intervertebral disk
  abnormalitiy. Sinogram- visualizes course
  of sinus tissues involved.
• CT- to identify soft tissue bone
  abnormalities, and various MS trauma. MRI- to
  view soft tissue- useful in the dx. Of ligament
  tears, osteomyelitis, disk disease.

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Assessment of the Musculoskeletal System

• Bone Mineral Density (BMD) measurements Dual
  energy x-ray absorptiometry (DEXA)- allows
  assessment of bone density with minimal radiation
  exposure- to monitor changes in bone density with
  treatment. Qualitative ultrasound (QUS)-
  evaluates density, elasticity strength of
  patella calcaneus using ultrasound rather than
  radiation.

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Assessment of the Musculoskeletal System

• Radioisotope Studies Bone scan- injection of
  radioisotopes that is taken up by bone, then scan
  entire body for degree of uptake-related to blood
  flow. Increased uptake- osteoporosis, Ca of the
  bone, fractures. Decreased uptake-avascular
  necrosis.

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Assessment of the Musculoskeletal System

• Endoscopy Arthroscopy- insertion of
  arthroscope into joint (usually knee) for
  visualization of structure and contents. It can
  be used for exploratory surgery (removal of loose
  bodies biopsy) and dx. of abnormalities of
  meniscus, articular cartilage, ligaments, or
  joints capsule. Other structures that can be
  visualized include-shoulder, elbow, wrist, jaw,
  hip and ankle.

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Assessment of the Musculoskeletal System

• Invasive Procedures Arthrocentesis- incision
  or puncture of joint capsule to obtain sample of
  synovial fluid from joint cavity or to remove
  excess fluid. Useful in dx. Of joint
  inflammation, infection, and subtle fractures.
• Electromyogram (EMG)- evaluates electrical
  potential associated with skeletal muscle
  contraction-useful in providing information
  related to lower motor neuron dysfunction and
  primary muscle disease.

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Assessment of the Musculoskeletal System

• Muscle enzymes- used to distinguish between
  muscle weakness that is due to nerve innervation
  problems and dystrophic disease of the muscle
  itself. The level of enzymes reflects the
  progress of the disorder and the effectiveness of
  treatment. Example- Creatine kinase (CK),aldolase.

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Assessment of the Musculoskeletal System

• Serologic Studies Rheumatoid factor(RF)-
  assess presence of autoantibody (RF) in serum.
• Erythrocyte sedimentation rate (ESR)- index of
  inflammation. Antinuclear antibody (ANA)-
  assesses presence of antibodies capable of
  destroying nucleus of bodys tissue cells.
• Anti-DNA antibody- detects serum antibodies
  that react with DNA. It is the most specific test
  for systemic lupus erythematosus.

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Assessment of the Musculoskeletal System

• Mineral Metabolism Alkaline
  phosphatase-produced by osteoblast of bone-needed
  for mineralization of organic bone matrix.
  Normal 20 to 90 U/L (0.3 to 2,7
  mmol/L). Calcium- bone primary organ for
  calcium storage. Normal 9 to 11 mg/dl (2.3 to
  2.7 mmol/L). Phosphorus- amount present
  indirectly related to calcium metabolism. Normal
  2.8 to 4.5 mg/dl (0.9 to 1,5 mmol/L)

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Assessment of the Musculoskeletal System

• Miscellaneous Thermograpgy- uses infrared
  detector, which measures degree of heat radiating
  from skin surface. Useful in investigation of
  cause of inflamed joint and in following up pt.s
  response to antiinflammatory drug
  therapy. Plethysmography- Study records
  variatios in volume pressures of blood passing
  through tissues. Nosspecific. Somotosensory
  evoked potebtial (SSEP)-evaluates evoked
  potential of muscle contractions. Help to
  identify neuropathy and myopathy.